The bottom line on well-being and health improvement

Countries where higher percentages of adults report that it is a good time to find a job are also more likely to have adult residents who report high levels of well-being. Adults in the 10 countries with the best jobs outlook are nearly twice as likely to be thriving in at least three of the five elements when compared with their counterparts in the 10 countries with the worst jobs outlook (20.9% and 12.9% of respondents, respectively).

The Gallup-Healthways Global Well-Being Index is a global barometer of individuals’ perceptions of their well-being and is the largest recent study of its kind. Data collected in 2013, across 135 countries and areas, and with more than 133,000 interviews, have been compiled into the State of Global Well-Being, a comprehensive report presenting the global demographics of well-being. The Global Well-Being Index is organized into the five elements:

Purpose: liking what you do each day and being motivated to achieve your goals

Community: liking where you live, feeling safe, and having pride in your community

Physical: having good health and enough energy to get things done daily

For each of the five elements, Gallup classifies those who responded as “thriving” (well-being that is strong and consistent), “struggling” (well-being that is moderate or inconsistent), or “suffering” (well-being that is low and inconsistent). Globally, 17% of adults are thriving in at least three of the five elements.

Jobs Climate Linked to Well-Being in Every Region Worldwide

The relationship between the jobs climate and well-being is consistent in every region of the world. In the former Soviet Union and in the Middle East and North Africa regions, this is particularly true. Those who report that their community or area is a good environment for job seekers are about three times more likely to be thriving in three or more elements of well-being than those who do not.

Positive Jobs Climate Most Positively Affects Community Well-Being

The five individual elements of well-being, in turn, all positively relate to a good jobs climate, highlighting the multidimensional effect the perceived availability of jobs can have on the well-being of those who live in such environments. Although there are benefits for adults across five elements, community well-being is most affected, underscoring the potentially significant role that the jobs environment plays in the pride residents have in their community and their willingness to participate in efforts to make it better.

Implications

The jobs climate and well-being share a reciprocal relationship, with each influencing the other. For example, areas — including countries — where residents have high well-being provide fruitful ground for potential employers, because they will have prospective employees who are active and productive while at work, miss few days of work due to poor health, and who have lower levels of healthcare use. In this manner, a citizenry with high well-being can drive economic vitality through an engine of jobs creation. At the same time, economic vitality and the good jobs that come from it will typically lead to residents having greater food, shelter, and healthcare security. They will also have greater pride in their communities, more secure relationships with their loved ones, better physical health outcomes, and a higher standard of living. All of these effects enhance well-being in tangible ways across each of the five elements.

It is important for world leaders to recognize that good jobs and well-being are closely linked, and that each can serve as a useful lever positively influence the other. In no regions worldwide is this influence more pointed than in the former Soviet Union and in the Middle East and North Africa, where a confluence of political uncertainty and violent conflict in many countries has created persistent unsteady conditions in a variety of ways. The nexus between jobs and the well-being of their populations may prove to be one of the most important vanguards of the long-term viability of these regions.

Survey Methods

Results for the Gallup-Healthways Global Well-Being Index are based on telephone and face-to-face interviews on the Gallup World Poll, with a random sample of approximately 133,000 adults, aged 15 and older, living in 135 countries and areas in 2013.

For results based on the total sample of national adults, the margin of sampling error is less than ±1 percentage point at the 95% confidence level. For results based on country-level samples, the margin of error ranges from a low of ±2.1 to a high of ±5.3.

All country-level analyses use country weights. Global and regional analysis uses projection weights that account for country size. Minimum sample sizes of N=300 apply.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Each element in the Global Well-Being Index contains two questions asked of all respondents:

Purpose

You like what you do every day.

You learn or do something interesting every day.

Social

Someone in your life always encourages you to be healthy.

Your friends and family give you positive energy every day.

Financial

You have enough money to do everything you want to do.

In the last seven days, you have worried about money.

Community

The city or area where you live is a perfect place for you.

In the last 12 months, you have received recognition for helping to improve the city or area where you live.

Physical

In the last seven days, you have felt active and productive every day.

Your physical health is near-perfect.

This article is the final entry in a series exploring worldwide perceptions of well-being in the five well-being elements of the Gallup-Healthways Global Well-Being Index: purpose, social, financial, community, and physical.

Many men adopt healthier habits to get ready for a major life event, such as a family wedding, class reunion or once-in-a-lifetime vacation. But lifestyle changes such as a healthier diet and more exercise can also help you avoid another major life event – a heart attack.

The study followed more than 20,000 Swedish men aged 45-79 for 11 years, and assessed lifestyle choices related to tobacco use, diet, alcohol consumption, physical activity and waist size. Men who combined a healthy diet and moderate alcohol consumption with not smoking, being physically active and maintaining a low amount of abdominal fat had an 86 percent lower risk of heart attack.

According to the authors, each individual lifestyle factor correlated with a clear reduction in risk, but a combination of the low-risk behaviors had the greatest impact. However, even incremental changes yielded improvement – not smoking, for example, decreases risk by 35 percent.

Dr. Dean Ornish also recommends combining multiple behavior changes to achieve maximum results in addressing heart disease and heart attack risk. His program is the first program that is scientifically proven to reverse heart disease by making changes in four areas. In addition to nutrition and fitness, the Ornish program also focuses on stress management and social and family support.

Changes in diet and lifestyle not only reduce your risk of a life-threatening event. Research shows that they also make a powerful difference in heart function and overall well-being. Patients in the Ornish cardiac rehabilitation program report that they feel more energized, enjoy a higher quality of life, can exercise longer and manage stress more effectively.

As patients, providers and employers are looking for ways to maximize well-being and minimize healthcare costs, preventing heart disease and modifying risk-related behaviors should be a priority. Heart disease is the leading cause of death in the United States, and 620,000 people suffer a first-time heart attack every year. According to the American Heart Association, direct and indirect costs of cardiovascular disease and stroke total more than $315.4 billion annually, including health expenditures and lost productivity.

Help is available to individuals who want to make a change. Many high-risk patients qualify for intensive cardiac rehabilitation programs such as the Ornish program, which is covered by Medicare and many other commercial insurance plans. Workplace programs that incorporate a holistic approach to well-being should offer assessments and interventions to improve cardiac health. The American Heart Association also offers extensive guidelines and tips on nutrition, physical activity and stress management.

Fewer than one in five adults worldwide can be considered thriving — or strong and consistent — in levels of purpose well-being, as measured by the inaugural Gallup-Healthways Global Well-Being Index in 2013. Residents living in the Americas are the most likely to be thriving in this element (37%), while those in Asia and the Middle East and North Africa are the least likely (13%).

The Global Well-Being Index measures each of the five elements of well-being — purpose, social, financial, community, and physical – through Gallup’s World Poll. Purpose well-being, which is defined as people liking what they do each day and being motivated to achieve their goals, was the lowest performing element of the five elements of well-being. Global results of how people fare in 135 countries and areas in this element, as well as the four other elements, have been compiled in the State of Global Well-Being report.

Latin Americans Have Highest Purpose Well-Being

Nearly all the countries with the highest thriving rates of purpose well-being in the world are in Latin America. Culture may play a role in these perceptions — Latin Americans generally report higher levels of positive daily emotions and have a better outlook on the job market than any other regional group. Denmark was the sole non-Latin American country in the top 10 countries with the highest percentage of the population that is thriving in purpose well-being.

Panama led the world in four of the five well-being elements — including purpose well-being. Two in three Panamanian adults were thriving in purpose well-being. Panama’s strong and growing economy with an unemployment rate of 4.5% in 2013, coupled with investments in national development could be contributing to these high levels of thriving in well-being. Neighboring Costa Rica followed at 50%, despite relatively high unemployment for the region — nearly 9% in the third quarter of 2013.

Asia and the Middle East and North Africa performed worst in purpose well-being, with only 13% of adults in these regions thriving in this element. However, when looking at adults’ perceptions at the country level, trends among countries emerge and the lowest percentages appear to be associated with conflict zones and countries with poor economic performance.

Afghanistan and Syria struggled most in this element and had the lowest levels of purpose well-being, with 3% or less of adults thriving in this element. These two countries along with Tunisia, and to a lesser extent, Armenia, are embroiled in armed conflicts, which have disrupted daily lives and prevented portions of the population from carrying out normal functions.

Poor economies may also have affected purpose well-being. With only 7% of the population thriving in purpose, Greece is grappling with an economy that has yet to recover from the European debt crisis. Croatia has also suffered negative GDP growth since 2009 and high unemployment rates compared with Western European countries.

High Purpose Well-Being Influenced by Demographics of
Education, Wealth, and Youth

Worldwide, demographics play a role in the likelihood that people are thriving in purpose well-being. Those who were in domestic partnerships or who had completed four years of education beyond high school were more likely to be thriving in purpose well-being (27%) than the global population as a whole (18%).

The wealthiest quintile, urban residents, the young, and office workers were also more likely to be thriving than their poorer, more rural, older, or non-office worker counterparts. Globally, however, there was no difference in the level of thriving between men and women. Eighteen percent of each were thriving in this element.

Globally, adults who were employed in the fishing, forestry, and agriculture sectors were the least likely group to be thriving in purpose well-being, with 11% of respondents providing responses that placed them in this category. Those with an elementary education or less followed at 13%.

The only region where education levels did not significantly affect people’s likelihood to thrive in purpose well-being was the Middle East and North Africa region, where 14% of those who have completed at least four years of education beyond high school are thriving in purpose, matching the 14% whose education did not go beyond the high school and tertiary level. In every other region surveyed, more highly educated respondents were significantly more likely to be thriving in purpose well-being than their less-educated counterparts in this element.

Women were significantly less likely to be thriving in purpose well-being (16%) than their male counterparts (20%) in former Soviet Union countries. The Americas saw women (36%) with slightly lower levels of purpose well-being thriving rates than their male counterparts (38%). There were no differences between genders in any of the remaining regions.

Implications

Purpose well-being is high when people like what they do each day and are motivated to achieve their goals. This is true whether they work for a company, are self-employed, care for family members, pursue education, work on a farm, or engage in charity work. Those with high well-being in this element also tend to be highly engaged in their work. They are emotionally invested in what they do and focus on creating value through their efforts.

When people are unable to find work or achieve other personal measures of success and well-being with respect to their purpose, it can impact areas beyond the individual and affect society as a whole. Such conditions fed the Arab Spring uprisings and fueled protests in European countries that enacted severe austerity cuts. In Panama, residents who have high purpose well-being (66% thriving) were more than twice as likely (at 37%) to have donated money to charity in the last year than were Mexicans (16%), whose purpose well-being level was only at a 33% thriving rate.

“It is important for any stakeholder who is interested in improving the health of their population including governments, community leaders, employers, insurers and other international organizations to understand the impact that purpose well-being has on overall well-being,” says Peter Choueiri, President, Healthways International. “Our research shows that purpose well-being has a high correlation with social, financial, community, and physical well-being. In other words, investments in purpose well-being improvement will likely also lift the other elements of well-being resulting in lower medical costs and an improvement in productivity across whole populations.”

Survey Methods

Results for the Gallup-Healthways Global Well-Being Index are based on telephone and face-to-face interviews on the Gallup World Poll, with a random sample of approximately 133,000 adults, aged 15 and older, living in 135 countries and areas in 2013.

For results based on the total sample of national adults, the margin of sampling error is less than ±1 percentage point at the 95% confidence level. For results based on country-level samples, the margin of error ranges from a low of ±2.1 to a high of ±5.3.

All country-level analyses use country weights. Global and regional analysis uses projection weights that account for country size. Minimum sample sizes of N=300 apply.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Each element in the Global Well-Being Index contains two questions asked of all respondents:

Purpose

You like what you do every day.

You learn or do something interesting every day.

Social

Someone in your life always encourages you to be healthy.

Your friends and family give you positive energy every day.

Financial

You have enough money to do everything you want to do.

In the last seven days, you have worried about money.

Community

The city or area where you live is a perfect place for you.

In the last 12 months, you have received recognition for helping to improve the city or area where you live.

Physical

In the last seven days, you have felt active and productive every day.

Your physical health is near-perfect.

This article is the second of three articles exploring worldwide perceptions of well-being in the five well-being elements measured in the Gallup-Healthways Global Well-Being Index: purpose, social, financial, community, and physical.

The Gallup-Healthways Global Well-Being Index™ provides fascinating insight into how people all around the world feel about their own well-being. The index uses a holistic definition of well-being and self-reported data from individuals to capture the important aspects of how people feel about and experience their daily lives, extending well beyond conventional measures of physical health or economic indicators.

Well-being has five prominent elements:

Purpose: Liking what you do each day and being motivated to achieve your goals

One in six adults worldwide are considered thriving — or strong and consistent — in at least three of the five elements of well-being, as measured by the inaugural Gallup-Healthways Global Well-Being Index in 2013. Residents of the Americas region are the most likely to be thriving in three or more elements (33%), while those in sub-Saharan Africa are the least likely (9%).

Each element of well-being is important on its own, but the elements are also interdependent and well-being is more than the sum of the elements. That only 17% of residents in the 135 countries and areas surveyed are thriving in three or more elements underscores how most of the world is struggling to achieve high well-being.

More adults globally are thriving in community well-being (26%) than in any other element. Residents in the Americas region, with more than one in three (37%) thriving, are most likely to be thriving in this element. Adults in sub-Saharan Africa are the least likely to be thriving (18%).

Fewer adults globally are thriving in purpose well-being than in any other element. Adults in Asia, as well as the Middle East and North Africa, are least likely to be thriving in this element (13% in each region), while those in the Americas again top the list of regions, at 37% thriving in purpose well-being.

Global Well-Being Index Largest Recent Global Study of Well-Being

The Global Well-Being Index is an extension of more than six years of research and 2 million interviews in the U.S. through the Gallup-Healthways Well-Being Index. The Global Well-Being Index is a global barometer of individuals’ perceptions of their well-being and is the largest recent study of its kind. Data collected in 2013, across 135 countries and areas, and with more than 133,000 interviews, have been compiled into the State of Global Well-Being, a comprehensive report presenting the global demographics of well-being. The Global Well-Being Index is organized into the five elements:

Purpose: liking what you do each day and being motivated to achieve your goals

Community: liking where you live, feeling safe, and having pride in your community

Physical: having good health and enough energy to get things done daily

In analyzing the results of the index, Gallup classifies responses as “thriving” (well-being that is strong and consistent), “struggling” (well-being that is moderate or inconsistent), or “suffering” (well-being that is low and inconsistent).

Thriving Rates Highest in Latin American and European Countries

Adults in Latin America are most likely to be thriving in well-being in three or more elements as well as across elements. Latin Americans generally report higher levels of well-being than any other regional group. This is consistent with other Gallup World Poll research that shows residents of Latin America generally evaluating their lives more highly than those in other regional groups, partly reflecting a cultural tendency in the region to focus on the positives in life.

Panama leads not only the region, but the world in four of the five well-being elements — purpose, social, community, and physical well-being. Sixty-one percent of Panamanians are thriving in three or more elements, 17 percentage points ahead of its second-place neighbor, Costa Rica (44%). Panama’s strong and growing economy, an unemployment rate of 4.5% in 2013, and national development may be the most significant factors contributing to its high thriving levels.

Financial well-being is the only element in which other countries’ residents top Panama’s. Swedes lead the world in financial well-being, with 72% thriving. Financial well-being is high across a range of northern and central European countries, including Austria (64% thriving), Denmark (59%), and the Netherlands (56%).

Only five countries outside of the Americas and Europe regions have levels of thriving within an element that rank in the top 10 of all countries — Bahrain in financial well-being (48%), Saudi Arabia in community well-being (43%) and physical well-being (39%), Malta in social well-being (47%), and Sri Lanka (50%) and the United Arab Emirates (49%) in community well-being. No countries outside of these two regions finished in the top 10 in thriving in three or more elements.

Sub-Saharan Africa Least Thriving Region

Adults in sub-Saharan Africa are the least likely to be thriving in three or more elements of well-being (9%), in addition to their low levels of financial well-being (9%), social well-being (16%), community well-being (18%), and physical well-being (20%). Democratic Republic of the Congo (DRC), Chad, Madagascar, Uganda, and Benin residents have some of the lowest levels of thriving in the world. Most of these countries are plagued by war, political turmoil, low levels of development, and endemic corruption. DRC, for example, has been embroiled in nearly continuous conflict since 1996, and is rife with political instability.

Although subjective well-being is dire in many sub-Saharan African countries, the situation is worse in Afghanistan and Syria. In 2013, just 1% of Syrian and Afghan adults were thriving in three or more elements; the two nations share the lowest well-being of the 135 countries and areas in the 2013 survey. Both countries are conflict zones. By the end of 2013, the United Nations High Commissioner for Refugees estimated that 6.5 million of a total population of 22 million Syrians would need humanitarian aid, and 4.25 million of those would be internally displaced.

Afghans are also awash in uncertainty about the country’s future security situation and its relative stability once foreign aid and investments level off. In a 2013 Gallup World Poll survey, more Afghans said their standard of living was getting worse than in any year since 2008, and most Afghans (61%) said it was a bad time for them to find a job. Against this backdrop, Afghans are the most likely of any population in the world not to be thriving in any element of well-being (75%).

Implications

Objective measures including GDP, life expectancy, and employment statistics are important and useful in assessing a country’s “success,” as are historical trends over time. However, the concept of subjective well-being encompasses the broader aspects of a life well-lived.

Gallup and Healthways research has shown that people with higher well-being are healthier, more productive, and more resilient in the face of challenges such as unemployment. People with higher well-being bounce back faster, are better able to take care of their own basic needs, and feel better able to contribute to and support the success of their organizations, communities, or countries.

Subjective well-being does not necessarily correlate with GDP, the presence of conflict, or other absolute indicators. Residents in poor countries may report that they have high well-being in certain well-being elements while those in wealthy countries may report that they have low well-being in particular elements. War-torn populations such as those in Syria may have extremely low well-being, but low levels are also found in countries that are relatively stable, such as Croatia and Italy.

There are policy implications for country leadership, development organizations, employers, health insurers (private and governmental), and others in the well-being status of their constituents. For example, Mexico has relatively high physical well-being scores. However, the country overtook the U.S. in 2013 as the most obese country in the Western Hemisphere and grapples with a high rate of diabetes. Diabetes and heart disease are the two most common causes of death in Mexico. While the physical well-being element captures more than just obesity, the high scores on this element in Mexico reveal areas where education is needed to help the population become more aware of health and healthy behaviors, and make better choices.

Because subjective well-being can correlate with outcomes such as healthcare costs, productivity, and business performance, world leaders should consider well-being, in addition to objective measures such as GDP, to provide a better picture of progress toward specific policy and development goals.

Survey Methods

Results for the Gallup-Healthways Global Well-Being Index are based on telephone and face-to-face interviews on the Gallup World Poll, with a random sample of approximately 133,000 adults, aged 15 and older, living in 135 countries and areas in 2013.

For results based on the total sample of national adults, the margin of sampling error is less than ±1 percentage point at the 95% confidence level. For results based on country-level samples, the margin of error ranges from a low of ±2.1 to a high of ±5.3.

All country-level analyses use country weights. Global and regional analysis uses projection weights that account for country size. Minimum sample sizes of N=300 apply.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Each element in the Global Well-Being Index contains two questions asked of all respondents:

Purpose

You like what you do every day.

You learn or do something interesting every day.

Social

Someone in your life always encourages you to be healthy.

Your friends and family give you positive energy every day.

Financial

You have enough money to do everything you want to do.

In the last seven days, you have worried about money.

Community

The city or area where you live is a perfect place for you.

In the last 12 months, you have received recognition for helping to improve the city or area where you live.

Physical

In the last seven days, you have felt active and productive every day.

Your physical health is near-perfect.

This article is the first in a series of three articles exploring worldwide perceptions of well-being in the five well-being elements of the Gallup-Healthways Global Well-Being Index: purpose, social, financial, community, and physical.

Almost seven years ago, we started on a journey with Gallup — a journey to measure well-being and explore the dimensions of a life well-lived. Our goal was to understand what is important to people, how we experience our day-to-day lives, and what we think our lives will be like in the future. We wanted to determine what distinguishes a thriving life from one spent suffering, to broaden the perspective that health is more than just physical. And we sought to understand how this more holistic definition of well-being could influence outcomes that are crucial to societies.

Through decades of research and with the help of many leading experts, we’ve been able to scientifically determine the elements of well-being that are the most predictive and actionable. These include our sense of purpose, our relationships, our financial security, our connection to our communities and our physical health. By thinking of well-being in this broader way, we can better understand the conditions affecting any population and, from there, develop targeted interventions that make a meaningful difference.

We’ve shown that even modest improvements in well-being can substantially lower healthcare costs and increase worker productivity within organizations. We’ve proven that scalable change can be realized across communities.

So where are we on our journey?

We continue to advance the science of well-being with Gallup to measure and study the well-being of populations globally. Together, we’ve amassed the world’s largest data set on well-being with more than 2 million surveys of U.S. adults. We’ve extended our reach around the world to create a “golden thread” of well-being information across 135 countries.

We now have a truly global picture of well-being. We can measure the elements that make up well-being, compare the relationships between well-being and other population metrics, and gauge the impact of well-being improvement initiatives in almost any country in the world. Our finding that only 17 percent of the world’s population is thriving in three elements or more tells us there’s much work to be done globally to improve well-being. This work includes promoting sustainable lifestyle changes and making environmental changes to develop communities that encourage high well-being.

We hope you’ll join us on this journey. It’s a journey that fosters thinking beyond traditional metrics that broadens our perspectives to include the essential elements that impact our daily lives. It’s a journey that connects well-being to any population that’s front-and-center for you — be it your employees, your community, your country, or, just as importantly, yourself and your family.

Measuring and understanding well-being matters to the employers that want to improve workforce performance, to the non-profits and international organizations that want to see positive outcomes in their development work, and to the governments that want to strengthen their communities. And it matters to all of us, as individuals who want to live better.

As a young surgeon some years ago, I had wonderful teachers and mentors who imparted to me a number of fundamental principles of practicing medicine. Though initially intended to be applied in clinical settings, a number of these principles I learned early on have sensible application to the complex domain of healthcare more broadly defined than traditional medicine and surgery. I’ve discovered this as I’ve increasingly devoted my career in recent years to the administrative side of medicine and healthcare.

For example, one mentor used to say that every patient – and more specifically, every surgical patient and every operation – had a “central tendon” which, when identified and “clipped,” made everything else seem minor and secondary. I quickly learned that this principle was significantly true in a clinical setting and have since realized it has much broader relevance.

As the Patient Protection and Affordable Care Act, aka ObamaCare, has swung into full gear with the opening of the exchanges and the expansion of Medicaid in 2014, virtually everyone believes that the healthcare industry has crossed into a very different place. This new reality has already begun to challenge our market’s brightest and most innovative minds to generate solutions that will position the American healthcare system as one to be emulated, rather than one that lags behind in virtually every imaginable dashboard metric. We as a country can do better…much better.

That said, here are a few observations regarding the current situation that I believe to be essential, beginning with my own view of what the “central tendon” might actually be. This short list is by no means intended to be comprehensive, rather just one person’s view of a few things that should be top of mind when thinking about how we fundamentally change and innovate our way out of the current reality with all of its issues.

Issue 1 – Physician Engagement

Others might have a different view, but I believe that “physician alignment” or perhaps preferably, “physician engagement” is just that central tendon issue, from which most all else in healthcare flows. Still the most respected and admired profession in the world, doctors always have and always will have a distinctive and irreplaceable role in the so-called conscience of the healthcare debate. (That in no way is meant to disrespect or undervalue the role of so many other healthcare professionals, especially that of nurses who will forever be the most intimate of partners with physicians at the sharp end of care. Enough said on that lest I be misunderstood.)

While not everyone will agree with me, I for one believe that our historically bifurcated payment schemes have ­– more than anything else over the last 75 years – driven doctors and hospitals further apart. Doctors ran the doctor business, and hospital administrators did likewise for facilities. Meanwhile, patients always thought of their care as “integrated,” and likely didn’t fully understand the distinction between professional and technical services. Nevertheless, we collectively have messaged within the industry something like this: “You take care of your business and I will take care of mine.”

The economic reality of where we are today, with our total healthcare spend being in excess of $2 trillion, cannot – and should not support – that kind of inefficiency and misalignment. We need the collective insight that both, really all, parties bring to the table. It is my belief that those hospitals and healthcare systems that “crack the code” when it comes to solving the physician relationship and engagement issue will be advantaged in the marketplace, regardless of local market forces and dynamics. The models for such alignment are numerous and certainly not confined to full employment and all should be fully explored.

Issue 2 – Healthcare Leadership

Second, and very much tied to the issue above, is the whole topic around leadership in healthcare. No, we don’t just need to train up an army of physicians with graduate business degrees to take over and fix what needs to be fixed. Rather, we need to thoughtfully and respectfully look at how leadership in healthcare has evolved and how narrowly focused we’ve been – something I think has happened from natural progress and isn’t anyone’s fault.

Regardless, our thinking about what healthcare is, where does it start and stop, who are the crucial stakeholders, where are the boundaries, and not least the question of role clarity are critical. We need to be intentional about leadership re-design, and we need to be bold. We need to build upon the strengths of the current leadership model, but not be constrained by it.

Much is said in today’s environment about taking risk, and most of the time we are talking about financial risk associated with the healthcare premium dollar. But we also need to think about bold risk-taking around leadership, empowering leaders to boldly redesign a model that is better suited and adaptable to where we are going, and not where we have come from. What are the skills and competencies that we need to anchor around? What perceived, but outdated, strengths do we need to jettison? Simply put, where do we need to build muscle, and how do we get the new muscle to work with the old.

This kind of change won’t just happen on its own, but needs to be led by a few brave organizations that will take it head-on. I believe that those organizations will be advantaged in the marketplace. In considering this challenge, organizations should think about the following three things:

Are our leaders currently equipped with the necessary skills and competencies to navigate the changing environment?

Is our leadership and shared governance model the right one for us?

Who do we need to engage to help us get from where we are to where we need to be?

Issue 3 – The Role of Boards

And one final thought: who is going to be the primary catalyst for change even if the only change we focused on were the two issues above? I for one believe that it is those who govern. One thing that has NOT changed in the current whitewater of healthcare is who has the final accountability for the long-term welfare of the organizations that make up the bedrock of our American healthcare system – our boards.

Given their connection to local communities, as well as their fiduciary responsibility to do what is best for those same communities, who else is better positioned to drive the challenging, and sometimes uncomfortable changes, that must take place? No longer can boards simply rely on what they learn from management regarding the current reality. They’re going to have to move into a posture that perhaps might be a little uncomfortable for all parties and begin to truly embrace a shared governance model. This shared model will more frequently challenges the status quo and isn’t reluctant to take the organizations that they serve to places that might seem a little daunting at first. A board might ask, “How much must we own, manage or control in order to have the kind of influence that we want to have on healthcare in this (our) market?” Make no mistake, boards will have a key and critical role in how the system of tomorrow is shaped.

As you see, the list is woefully incomplete, but we have to start somewhere. Many believe that the traditional players in healthcare cannot transform an industry as large and entrenched as is ours. I respectfully disagree and believe that real transformation from episodic acute care to true population health and comprehensive well-being can and should most effectively be led by those same people.

So as for me ….

Transformational physician engagement partnered with a …

Transformational leadership paradigm that is insisted upon by …

Transformational boards of governance willing to push the envelope

Not a bad place to start and we’re happy to help out!

This article will also be published on the Navvis Healthways blog and appears with permission of the author.

As senior vice president for Navvis Healthways, Dr. Anderson provides strategic counsel, planning and implementation support for physician integration and alignment, accountable clinical management, and strategic planning for the organization. Before joining Navvis Healthways, Dr. Anderson served as a senior vice president and chief medical officer for Baylor Health Care System in Dallas from 1995 until 2004, and held the same position at Catholic Health Initiatives (CHI) in Denver from 2004 until 2008. Dr. Anderson’s clinical background is that of a general and vascular surgeon. He holds an M.D. from the Baylor College of Medicine and a B.S. from Baylor University.

Improving well-being can create a vast range of positive outcomes, such as better quality of life, increased longevity, greater on-the-job productivity and lower healthcare costs. Research has shown that overall well-being is a stronger predictor of health and performance outcomes over time than factors such as people’s demographic characteristics, the amount of healthcare they’ve used, and their behavioral and physical health risks alone.* According to Jim Clifton, Gallup chairman and chief executive officer, “The most important dial on any leader’s dashboard for the next 20 years will be well-being”.

If your organization understands that well-being is an important aspect of its success, step one in putting this knowledge to work, then, is to establish a baseline measure of well-being. This will enable you to determine the effectiveness of any programs you put in place to improve well-being. Sounds easy, right?

It’s actually a highly complex endeavor. Health risk assessments abound in the market, but well-being is much more than physical health. Therefore, measurement tools need to capture information about all five of the interrelated elements of well-being: purpose, social, financial, community and physical.

The Well-Being 5 is based on decades of scientific research by Gallup and Healthways. Experts evaluated hundreds of well-being questions and millions of responses to determine specific question and response wording and question order. The final set of questions in the Well-Being 5 was chosen based on its power to identify risk, comprehensively capture well-being, and predict outcomes with optimal validity, accuracy and precision. The survey experience is designed to maximize both engagement and action, applying principles that include:

Making the best choice the easy choice

Suggesting direct action

Moving the individual through the experience in increments that allow for learning

Providing feedback on what is most valuable to that individual

The new study concludes that the Well-Being 5 “comprehensively captures the known constructs within well-being, is reliable and valid, significantly relates to health and performance outcomes, can be diagnostic and informative for intervention, and can be used to track and compare well-being over time and across groups. Using the Well-Being 5 instrument, well-being issues within a population can be effectively identified, prioritized and addressed, yielding substantial improvements to the health status, performance, functioning, and quality of life for individuals.”

As more organizations look to well-being improvement to help them reduce healthcare costs and improve performance, a reliable and validated tool such as the Well-Being 5 can help. Learn more about the Well-Being 5.

* This sentence was edited on August 28, 2014 to include the word “alone.”

New data from the Gallup-Healthways Well-Being Index® demonstrates that, despite the many hiccups associated with rolling out provisions of the Patient Protection and Affordable Care Act (ACA), the healthcare law has led to a tremendous shift in health insurance coverage. In the third quarter of 2013, 18 percent of Americans were without health insurance; by the first quarter of 2014, that number was down to 13.5 percent, its lowest point in years.

Check out our newest infographic, which reveals some fascinating insights from Gallup-Healthways research, including which states are seeing the greatest percentage of their residents without insurance as well as how health insurance coverage affects well-being.

In a report released in July, the Urban Institute found that 5.3 percent of American adults have a debt past due – meaning anywhere from 30 to 180 days late. To become current on these debts, these individuals would have to pay an average of approximately $2,300 per person. Even more alarming, the study also revealed that 35 percent of American adults have a non-mortgage debt in collection (more than 180 days past due). These 77 million Americans owe an average of about $5,200 each.

As we’ve discussedbefore in this blog, financial well-being is one of the five inter-related elements of well-being – along with purpose, social, community and physical. Because these elements are interdependent, low financial well-being can negatively affect the other elements. Low financial well-being can adversely impact physical and emotional health, put incredible strain on family and social relationships, decrease people’s interest or ability to engage in their community, and otherwise act as a barrier to people living their best lives. At work, it can make an employee less productive (imagine trying to get an important project finished if your water is in danger of being shut off) and less willing to engage in any well-being improvement programs offered by the company. In short, financial well-being matters – a lot. We should all be talking about it and devising ways to improve it.

Dave Ramsey is someone who talks about financial well-being and the ways in which individuals and families can alleviate financial stress. Considered America’s trusted resource on money, his straightforward approach to financial management, household budgeting, debt reduction and savings has been put into practice by millions of Americans. Perhaps most importantly, Ramsey understands that the key to improving financial well-being is achieving and sustaining behavior change, one step at a time.

One of the millions of people Ramsey has helped, a guy named Vince, recently garnered some media attention when he posted a hilarious online advertisement listing an amp for sale. In the ad, Vince laments, “Dave Ramsey ruined my life” by advocating “tightening the old spending belt and saving all of your disposable income.” The tongue-in-cheek tone of the ad has Vince remembering with nostalgia a former period in his life when he could buy things that brought him fleeting enjoyment but added to his household debt. To keep faithful to Ramsey’s philosophy, Vince is selling his amp to earn enough cash to purchase an acoustic guitar he’s been eyeing.

Vince decided to sell his amp so he could earn enough cash to buy an acoustic guitar. With this kind of savvy approach to money, he hopes to avoid being one of the 40% of Americans with past-due debts.

A follow-up article to the ad captures Vince’s more sincere feelings toward Ramsey’s approach. Vince says, “[I]t’s given my wife and me something concrete that we can be together on regarding finances,” noting that “having unified financial goals plays a big role in marital harmony.”

Although Vince’s ad puts a humorous spin on raising your financial well-being, it’s an incredibly serious issue. Unless people are able to adopt new attitudes and behaviors toward their money, we’ll likely continue to see staggering statistics like those in the Urban Institute study for some time to come.